| NPI | 1407523657 |
|---|---|
| Doing Business As | AGESTRONG MIRABELLA ASU |
| Entity Type | Organization |
| Authorized Contact | PHILLIP G FOGG Owner 971-206-5200 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2024-02-19 |